=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548879794
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VASCULAR SPECIALIST OF VENICE AND SARASOTA PL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2020
-----------------------------------------------------
Last Update Date | 07/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6600 UNIVERSITY PARKWAY #102
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-378-3231
-----------------------------------------------------
Fax | 941-308-7337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 N CATTLEMEN RD STE 100
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-6422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-378-3231
-----------------------------------------------------
Fax | 941-308-7337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCESS MANAGER
-----------------------------------------------------
Name | BARRIE LAZARUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-316-1101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------